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Could Navy submarine smoking ban lead military to quit?

A US Navy ban on smoking aboard submarines may offer lessons for enacting similar prohibitions in other parts of the military as well as in civilian life, a new paper suggests.

On the last day of 2010, after decades of hurdles, Navy officials ordered all its underwater ships to become smoke free, and it’s been smooth sailing for the submarine smoking ban since then.

“This was a long time in coming,” one of the researchers, Dr. Larry Williams, told Reuters Health. “This is one great victory, and we may use it to build on.”

Williams, a retired Navy dentist, chaired the Navy Medicine Tobacco Cessation Action Team. He grew up on a Tennessee tobacco farm, watched his relatives die of smoking-related illnesses and developed the Navy’s first smoking-cessation program nearly 30 years ago.

The submarine smoking ban laid the foundation for a current Department of Defense review of military smoking, Williams said. The ongoing review could lead to other smoke-free military installations and to the end of military tobacco sales.

Following implementation of the smoking ban, Williams talked to sailors in Pearl Harbor, Hawaii; Norfolk, Virginia; and San Diego, California.

“The common theme was, ‘we’ve been ordered to do it, and we’re going to make it work.’ They took it as a fact of life, just as if they were ordered to wear their uniform to work,” he said.

The submarine community had assumed that high-tech equipment known as “scrubbers” removed secondhand smoke when ships were under water. But research showed that nonsmokers’ urine levels of cotinine more than doubled when they were living on submarines, the authors write in Tobacco Control. Cotinine is a biomarker for tobacco exposure.

The Navy spent more than a year preparing for the submarine smoking ban and pitched it as essential to the health of involuntarily exposed nonsmokers. Commanders made the case that the likelihood of dying from secondhand smoke was comparable to dying in a motor vehicle accident and greater than dying from a combination of fire, falling and drowning, the report says.

“The goal was not to punish smokers but to make sure they were protecting the nonsmokers,” epidemiologist Walker Poston, another of the study’s authors, told Reuters Health.

Smokers were offered counseling and nicotine-replacement patches and gum and were given time to complete cessation programs before the ban. Nearly 25 percent of military personnel smoked in 2011, down from 51 percent in 1980, the study says.

“This shows that science and leadership work hand in hand,” Williams said. “The science shows that smoking harms the readiness of the force.”

Smokers’ wounds take longer to heal, their run times are slower, and they have higher rates of injury and post-traumatic stress disorder, said Poston, from the National Development and Research Institutes in Leawood, Kansas.

“Quitting smoking for most smokers is probably the most significant things they can do for their health. It’s not just that 20 to 30 years down the road they may be at greater risk for heart disease and lung cancer,” he said.

Five years ago, a report from the Institute of Medicine, an independent nonprofit, called for a tobacco-free military. The report estimated the military’s annual cost of tobacco-related diseases at more than $500 million for medical care and $346 million in lost productivity. The yearly bill for veterans’ smoking-related medical care runs into the billions, the report says.

In 1985, Williams began advising patients aboard an aircraft carrier to quit smoking, and soon after he developed the Navy’s first smoking-cessation program. Along the way, he met resistance from the tobacco industry as well as members of Congress.

In 1993, a commanding officer announced a smoking ban aboard the USS Theodore Roosevelt based on reports about the dangers of secondhand smoke.

But tobacco-friendly members of Congress stopped the ban before it took effect, the authors of the current study write. In the mid-1970s, smoking was allowed virtually everywhere aboard submarines, the study says. By the year 2000, smokers were contained to two six-by-six foot areas on subs.

Williams counted his victories one at a time with each patient he helped kick the habit.

“The tobacco lobby’s very strong, and it’s long been held that the military and tobacco go hand in hand,” he said. “People think tobacco use is a way of taking a break, that it’s an entitlement. But it’s really not.”

Robert Proctor, a Stanford University history of science professor, applauded the Navy for making submarines smoke free but bemoaned the fact that it took so many years. Proctor was not involved in the current study.

“The industry has exploited and abused our men and women in uniform,” he told Reuters Health, “but here we have an example of military leaders taking a courageous and successful stand against the product that still kills 480,000 Americans every year.”